Profiles in Resilience - Physicians for Human Rights Why Survivors of Domestic Violence and Gang Violence Qualify for International Protection
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Physicians for Human Rights Profiles in Resilience Why Survivors of Domestic Violence and Gang Violence Qualify for International Protection June 2021
Contents Acknowledgments
3 Executive Summary This report was researched and written by faculty and student researchers at the University of
7 Introduction California, Los Angeles (UCLA), in collaboration with Physicians for Human Rights (PHR) staff.
Eleanor Hope Emery, MD, former member of the faculty at UCLA and now instructor of medicine
8 Background
at Harvard Medical School and program officer at Cambridge Health Alliance’s Center for Health
10 Methodology Equity Education & Advocacy, co-led the development of the overall study design and the
12 Findings development and implementation of the study’s methods, including the creation of the coding
34 Legal and Policy tool used for data abstraction. She also assisted in data abstraction and qualitative analysis and
Framework led the preparation of the manuscript. Adam Richards, MD, PhD, MPH, former member of the
42 Conclusions faculty at UCLA and now associate professor of global health at the George Washington
University Milken Institute School of Public Health, co-led the development of the overall study
43 Recommendations
design and the development and implementation of the study’s methods, including the creation
45 Annex of the coding tool used for data abstraction. He was responsible for statistical analysis and
48 Endnotes reporting and assisted with data abstraction, qualitative analysis, and preparation of the
manuscript. Mehar Maju, MPH, graduate of the UCLA Fielding School of Public Health,
contributed to the implementation of the study’s methods and assisted in data abstraction,
qualitative analysis, and preparation of the manuscript. Kate Coursey, medical student at the
David Geffen School of Medicine at UCLA, assisted with data abstraction, qualitative analysis,
and preparation of the manuscript. Cameron Brandt, MPH, MA, public health specialist at the
UCLA Fielding School of Public Health, assisted with data abstraction, qualitative analysis, and
preparation of the manuscript. Jamie S. Ko, MPH, medical student at the David Geffen School of
Medicine at UCLA, implemented the coding tool via Qualtrics and assisted with data abstraction.
Kathryn Hampton, MSt, PHR senior asylum officer, assisted with the development of the overall
study design, the development and implementation of the study’s methods, and with qualitative
analysis. She also drafted the legal analysis and policy recommendations.
The authors would like to thank the Los Angeles Human Rights Initiative, a student-run
organization at UCLA that provides pro bono forensic evaluations to asylum seekers, for coding
the affidavits and making this study possible. The authors would like to acknowledge the
following people for their contribution to the development of the coding tool used for data
abstraction in this project: Neela Chakravartula, Sonya Gabrielian, Hajar Habbach, Roya Ijadi-
Maghsoodi, Taylor Kuhn, Arash Nafisi, Altaf Saadi, Joe Shin, and Aparna Sridhar. The authors
would like to acknowledge the following people for their assistance with data abstraction for this
project: Hala Baradi, Catherine Bradley, Gabrielle Daso, Kendall Dunlop-Korsness, Jenny
Huang, Preeti Kakani, Esther Kim, Victoria Lee, Leslie Ojeaburu, Jenna Paul-Schultz, and
Sophia Taleghani.
The report benefitted from review by PHR staff, including Michele Heisler MD, MPA, medical
Cover: A woman who director; Ranit Mishori, MD, MHS, senior medical advisor; Karen Naimer, JD, LLM, MA, director
fled Honduras with her of programs; Joanna Naples-Mitchell, JD, U.S. researcher; Michael Payne, senior advocacy
family after her husband officer; Cynthia Pompa, asylum officer; Elsa Raker, asylum program associate; Susannah Sirkin,
witnessed a murder and MEd, director of policy and senior advisor, and Raha Wala, JD, director of advocacy.
the family was attacked
by armed men affiliated The report also benefitted from external review by PHR board member Donna Shelley MD, MPH.
with a local gang.
The report was edited and prepared for publication by Claudia Rader, MS, PHR senior
Photo: PHR photo library
communications manager, with assistance from Alissa Flores, communications intern. Hannah
Dunphy, digital communications manager, prepared the digital presentation.
NOTE: The photographs included in this report were taken during the course of a research
project for a PHR report entitled “’If I went back, I would not survive.’ Asylum Seekers Fleeing
Violence in Mexico and Central America,” which was based on medical evaluations conducted
by some of the same researchers who wrote this report. While the people depicted are not the
same individuals cited in this report, their stories and health outcomes are illustrative of the
broader trend uncovered in this research project.
Profiles in Resilience: Why Survivors of Physicians for Human Rights phr.org 2
Domestic Violence and Gang Violence
Qualify for International Protection
Executive Summary
Introduction
Although protection for refugees is a longstanding U.S. legal commitment under
federal and international law, immigration policy has become a deeply politicized
topic in the United States in recent years. Domestic violence and violence by
organized gangs represent a major cause of forced displacement for those
arriving at the U.S. border. Yet these forms of persecution are viewed skeptically
by some policymakers who favor restricting immigration in spite of U.S. legal
obligations to ensure the right to seek asylum.
Extensive data demonstrates that the increase in migration from Central America
to the United States in the past decade has been triggered by physical and sexual
violence, death threats, and other abuses by organized gangs, domestic abusers,
and government authorities, resulting in high levels of physical and psychological
trauma. The Trump administration dismissed these claims as “meritless” and
asylum seekers as “fraudsters” who exploit the “loophole” of asylum, alleging that
they are actually criminals. Former attorney general Jeff Sessions flouted decades
of domestic and international legal precedent by issuing a blanket statement, in a
single case, that domestic and gang violence survivors will generally not qualify
for asylum. This decision had the immediate impact of increasing denials of
Central American asylum claims, in line with the political goals of the Trump
administration to deter migration from Central America.
Research and methodology
A large proportion of Physicians for Human Rights (PHR) clients, who are
asylum seekers receiving pro bono forensic evaluations, are survivors of domestic
and gang violence. A research team, comprised of faculty from the University of
California, Los Angeles (UCLA), graduate students from the UCLA Fielding
School of Public Health, medical students at the David Geffen School of Medicine
at UCLA, and PHR staff, analyzed 132 medical-legal affidavits resulting from
medical and psychological evaluations of asylum seekers to capture the
characteristics of the harms they experienced. The study also explored descriptive
statistics that could expose discriminatory patterns of harm that were not
captured through the qualitative analysis. Our hypothesis was that the physical
and psychological findings in medical-legal affidavits would bring new insights
that could inform efforts to change asylum policies.
Research findings: Significant trauma exposure from domestic
and gang violence
In this study, 81 percent (107 people) of the applicants were seeking asylum due
to domestic violence and 29 percent (38 people) due to persecution by organized
gangs; 10 percent (13 people) had experienced both domestic and gang violence.
According to data from the affidavits, the applicants reported a wide range of
trauma: of 26 types of trauma, almost two thirds (65 percent) of applicants had
experienced six or more types. Nearly all (95 percent) of the applicants had
experienced multiple trauma categories: 78 percent had experienced three or
Profiles in Resilience: Why Survivors of Physicians for Human Rights phr.org 3
Domestic Violence and Gang Violence
Qualify for International Protection
The increase in migration from Central America
to the United States in the past decade has
been triggered by physical and sexual violence,
death threats, and other abuses by organized
gangs, domestic abusers, and government
authorities, resulting in high levels of physical
and psychological trauma.
more categories of trauma while 15 percent had experienced all five trauma
categories. Overall, sexual violence was very common in gang violence-related
claims, with one third of applicants in this category reporting having been raped
and five percent reporting a history of “gang rape” or rape by two or more
perpetrators.
Overall, 38 percent of applicants in this sample reported having a family member
who had experienced violence or had been killed as a sign that they were likely to
be targeted next. Perpetrators commonly threatened family members as a
powerful means of coercing, threatening, or exploiting their specific targets.
Nowhere to flee: Lack of community or state protection from
domestic and gang violence
Affidavits captured the complicated social and gender norms, sense of male
entitlement, and systemic disempowerment of women that motivated intimate
partners to inflict physical and sexual violence. These pervasive beliefs about the
obligations of women within intimate relationships were prevalent amongst
perpetrators and local community members.
Parents, guardians, and extended family members also perpetrated physical
violence (50 percent) and sexual violence (19 percent). Many clients reported that
their family members were motivated by adherence to social, religious, and
community norms, such as the maintenance of male-dominant power structures
within the family or the avoidance of familial “shame” caused by non-conformity
to these customs.
Of the 132 affidavits analyzed, 32 (24 percent) reported that the person sought
After the father was extorted,
beaten, and threatened with
death by a local gang, this
family fled El Salvador rather
than go to the police, who they
said were in collusion with the
gangs.
Photo: PHR photo library
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Domestic Violence and Gang Violence
Qualify for International Protection
People reported that the state was unable or
unwilling to protect them due to corruption,
fear, normalization of domestic and gang
violence in the community, and stigmatizing
attitudes towards victims.
assistance from a police, military, or government official or civil society
organization. For 81 percent of those who sought assistance, there was either no
response or the report resulted in direct persecution by the state actor. People
reported that the state was unable or unwilling to protect them due to corruption,
fear, normalization of domestic and gang violence in the community, and
stigmatizing attitudes towards victims. More than a third of the people described
in our sample (49 people or 37 percent) attempted to relocate within their home
country prior to migrating to the United States, including 22 people who
attempted to relocate more than once.
For many asylum seekers, arrival in the United States did not mean that they had
found safety. Almost half of the subjects in the sample (46 percent) reported
ongoing trauma after entering the United States. This trauma often took the form
of ongoing threats by former persecutors through phone or social media. Other
applicants reported experiencing new forms of abuse after arrival in the United
States, including by harassment or assault in their new workplace or abuse by
new intimate partners. Other types of abuse that were reported after arrival in the
United States included trauma related to detention and forced prostitution.
Physical and mental health effects of trauma
Of the 101 affidavits in this sample that included a mental health evaluation, 79
percent met criteria in the Diagnostic and Statistical Manual of Mental Disorders
(DSM–5) for a mental health diagnosis. Post-traumatic stress disorder (PTSD)
was the most common diagnosis, with 68 percent of people who underwent a
mental health evaluation meeting criteria for this diagnosis. Suicidality was also
very common, with 32 percent of people reporting any history of suicidal ideation
or attempt and 13 percent reporting active suicidality at the time of the
evaluation.
Of the 50 evaluations that included a physical evaluation, the most common types
of physical injuries reported were cuts (28 people, 56 percent) followed by burns
(12 people, 24 percent).
The majority of clinicians in this sample concluded there was objective physical
or psychological evidence of past trauma consistent with, highly consistent with,
or diagnostic of the history of trauma described by the applicant.
Resilience of survivors
Many affidavits commented on resilience factors that helped the applicants
recover from their prior trauma and adjust to a new life in the United States.
These resilience factors included family and social support, religion and collective
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Domestic Violence and Gang Violence
Qualify for International Protection
identity, work and school, access to mental and other clinical health services, and
individual traits. Mental health improvement was strongly associated with the
number of reported resilience factors. Improvement in mental health was
reported in 74 percent of subjects who reported two or more resilience factors,
compared to 14 percent of subjects who reported no resilience factors.
Legal protections for refugees fleeing domestic and gang
violence
The Refugee Convention defines a refugee as someone who is unable or unwilling
to avail themselves of the protection of their country from persecution, for the
reasons, or “protected grounds,” of race, religion, nationality, membership of a
particular social group, or political opinion. The UN High Commissioner for
Refugees (UNHCR) advises that domestic violence and gang violence survivors
may be considered “members of a particular social group” due to their gender, or
due to gender with their relationship status or national origin, and that in gang
violence cases, survivors can be considered members of social groups which are
defined as groups by their past actions or experiences, such as resisting gang
recruitment or refusing to pay extortion money to gangs. Opposition to gang
activity and domestic violence can also be understood as a type of political
opinion. According to UNHCR, persecution by non-state actors, such as gang
members or violent family members, should be recognized whenever a
government is unable or unwilling to control the perpetrators.
Conclusions
The data in this study provides additional evidence that the harms suffered by
asylum seekers from domestic and gang violence are real and severe, and that
victims often cannot find protection in their own country. These narratives of
abuse and trauma in this study were consistent with mental and physical health
evidence, as documented according to international standards contained in the
Istanbul Protocol.
Domestic and gang violence survivors can meet the criteria for international
protection, especially when their persecution and inability to obtain protection is
understood through a gender lens. The Biden administration should revise
Department of Homeland Security and Department of Justice regulations to
ensure that U.S. asylum law is consistent with international refugee law
standards in the protection that it offers. Ultimately, Congress should amend the
Immigration and Nationality Act to codify these standards at the level that
international law requires.
Refugees, asylum seekers, and all immigrants must be treated humanely. The
people whose narratives are described in this study were bona fide applicants
who were granted asylum in the United States after experiencing severe harm in
The data in this study provides additional
evidence that the harms suffered by asylum
seekers from domestic and gang violence are
real and severe, and that victims often cannot
find protection in their own country.
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Qualify for International Protection
their home countries, often over many years and by multiple perpetrators. Some
46 percent of them reported experiencing ongoing trauma in the United States,
most commonly due to ongoing threats to themselves or their loved ones and new
experiences of domestic violence in the United States. For some, mistreatment in
detention, separation from family, inability to work, and anxiety about their
asylum cases also caused deteriorating mental health symptoms after they
arrived in the United States. Nevertheless, this study demonstrates the resilience
of these applicants and the possibility for healing for those who are able to find
safety in the United States. Statistical analysis showed that those who did not
experience ongoing trauma in the United States or who had factors that promote
resilience, such as family and community support, opportunities for religious
engagement, employment, and education, and access to mental and other clinical
health services, had significantly better health outcomes. These courageous
survivors can heal if we ensure respect for their dignity, well-being, and human
rights.
Introduction
Immigration policy has become a deeply politicized topic in the United States in
recent years, even to the point of undermining historic public support for and
understanding of asylum protection for those fleeing harm. Current debates
represent a stark contrast with the longstanding refugee regime ensured under
U.S. and international law. Domestic violence and violence by organized gangs
that occur with impunity represent a major cause of forced displacement for
those arriving at the U.S. border. Yet these forms of persecution are viewed
skeptically by some U.S. policymakers who favor restricting immigration and
argue that asylum should be limited to a few singular dissidents, rather than
serve as a meaningful mechanism for states to share responsibility for global
persecution and forced displacement trends.
A growing proportion of Physicians for Human Rights (PHR) clients who are
asylum seekers receiving pro bono forensic evaluations are survivors of domestic
and gang violence. The physical and psychological trauma caused by domestic
and gang violence is substantial. The narratives of these survivors shed light on
community attitudes toward gender identity, gender-based persecution, and
dynamics of persecution by non-state actors, as well as the nature and meaning of
state protection of human rights.
Immigration experts were deeply concerned by the rollback of protections for
domestic and gang violence survivors under the Trump administration. These
changes undermined decades of hard-won progress in establishing violence
against women as a human rights violation and seriously addressing human
rights abuses by non-state actors, while the Refugee Convention generally
contemplated government persecution.1 Refugees themselves as well as legal
counsel and others serving affected communities are often best placed to drive
development of refugee law, in collaboration with adjudicators, international
organizations, and academia, because their data reflect the lived experiences of
people forced into flight.2 Toward this end, we sought to explore gender-based
persecution (including gendered forms of violence by organized gangs) and state
failure to protect victims due to gender-based discrimination in law enforcement
and judicial response through the experiences of people who lived those realities.
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Domestic Violence and Gang Violence
Qualify for International Protection
This study specifically examines more than 100 detailed cases of people who were
successful in obtaining asylum in the United States from 1999 to 2019 due to
their membership in a particular social group as the protected ground; this
violence was mainly perpetrated by non-state actors. We focused on this
population because it has been targeted by recent policy changes as being
generally unworthy of international protection. This study seeks to describe the
dynamics and characteristics of the harm these asylum seekers experienced that
are relevant for their legal cases, including the severity of harm, community and
government responses to persecution, and targeting based on their immutable
characteristics, such as kinship ties. Describing the characteristics of this group
through analyzing their lived experiences is important to inform advocacy efforts
which seek to advance U.S. asylum policies that protect survivors of domestic and
gang violence. A unique finding in this study captures the resilience of survivors
who have access to community and social support.
Background
Violence by organized gangs represents a serious threat to human rights.
According to data from the United Nations Office on Drugs and Crime, in 2017
more people were killed worldwide in unlawful killings than in armed conflict,
with Central America being the most dangerous region for unlawful killings.3 The
World Health Organization (WHO) reports that around 200,000 young people
aged 10-29 are killed each year, with 83 percent of the victims of unlawful killings
being boys and young men.4 Criminal gangs are often deeply embedded in the
political system, leveraging coercive power to eliminate opposition and to
promote candidates who will ensure a permissive environment for gang
activities.5 The political dimension of gang operations means that individuals
often do not have any safe option for reporting violence or threats without fear of
violent reprisal.6
Globally, violence against women is an endemic public health problem and
human rights violation, with WHO data indicating that almost a third of women
worldwide (27 percent) are subjected to intimate partner violence during their
lifetime.7 In 2015, El Salvador and Honduras ranked third and fifth in the world
in the rate of violent deaths of women; social norms and legal culture mean that
only a fraction of these cases are opened and an even smaller fraction result in
conviction.8
Demographics of migrants arriving at the U.S. border have changed over the past
decade. While fewer people are crossing the border each year than in prior
decades, more people are seeking asylum from Central America, and an
increasing proportion are families and children. The majority of people
apprehended by U.S. Border Patrol are from the Central American countries of El
Salvador, Guatemala, and Honduras, countries with some of the highest rates of
In 2017 more people were killed worldwide in unlawful
killings than in armed conflict, with Central America
being the most dangerous region for unlawful killings.
The WHO reports that around 200,000 young people
aged 10-29 are killed each year, with 83 percent of the
victims of unlawful killings being boys and young men.
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Domestic Violence and Gang Violence
Qualify for International Protection
Brothers who fled their home in Honduras with their parents after the family was attacked by armed
men affiliated with a local gang.
Photo: PHR photo library
homicide in the world.9 Applications for asylum in the United States increased
seven-fold from Fiscal Year (FY) 2009 to FY2013, with 70 percent of that increase
due to asylum applications from these three countries.10 From 2012 to 2017, there
was a rise again in asylum applications from people from Central American
countries, this time an almost eight-fold increase, with increasing numbers of
families and unaccompanied children as applicants.11 Extensive data
demonstrates that the increase in migration from Central America to the United
States in the past decade has been triggered by physical and sexual violence,
death threats, and other abuses by organized gangs, domestic abusers, and
government authorities, resulting in high levels of physical and psychological
trauma.12
Asylum grant rates have also increased, underscoring the bona fide nature of
these claims and their merit under U.S. asylum law: from 2010 to 2016, there was
a 96 percent increase in the percentage of asylum seekers from the Central
American countries of El Salvador, Guatemala, and Honduras who were granted
protection.13
Nonetheless, with no evidence of change in root causes of displacement, the
Trump administration abruptly dismissed these claims as “meritless” and asylum
seekers as “fraudsters” who exploit the “loophole” of asylum, alleging that they
are actually criminals.14 In addition to deterrence policies of family separation,
the “Remain in Mexico” policy, and expulsions, lesser known changes to
interpretation of asylum law were mostly overlooked by the media, but struck a
devastating blow at the core of asylum protection. Then Attorney General Jeff
Sessions overturned an asylum decision for a domestic violence survivor from El
Salvador, Matter of A-B-, and used that case to reverse decades of precedent,
making a sweeping statement that domestic and gang violence survivors
generally will not qualify for asylum. Other decisions and regulations followed,
further undermining protections for domestic and gang violence survivors. A
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Domestic Violence and Gang Violence
Qualify for International Protection
In 2015, El Salvador and Honduras ranked third and
fifth in the world in the rate of violent deaths of women.
legal database documenting 50 unpublished Board of Immigration Appeals
decisions following Matter of A-B- found that 37 applications were denied and 13
were remanded, using the decision as a reason to disqualify applications based on
domestic or gang violence.15 Although Matter of A-B- did not mention specific
countries, it resulted in a dramatic drop in asylum cases for people applying from
Central American countries before and after the decision. Asylum grant rates fell
from 23.9 percent for Central Americans in the first half of 2018 to only 14.4
percent in the second half of the year following the decision, while applicants
from other countries received asylum 47 percent of the time and experienced only
a 0.5 percent decrease during the same period.16 In contrast, in Canada, asylum
seekers from El Salvador obtained asylum in 69 percent of cases.17
What this means is that many people with a well-founded fear of severe harm
were deported from the United States after being denied asylum. In-depth
research has shown that people deported from the United States to Central
America were subsequently killed at high rates for reasons connected with their
original reason for fleeing their country,18 with the LGBTQIA+ population facing
particularly high risks of harm.19 Influenced by the United States, Mexico is
deporting increasing numbers of Central American asylum seekers, including
children, to face danger in their home countries in violation of Mexico’s domestic
law and international law obligations.20 However, research has shown that even
harsh and punitive deportation policies and practices have not stopped the flow
of migration, which is primarily driven by violence in applicants’ country of origin
as a push factor.21 Statistical analysis of U.S. government apprehensions at the
border indicates that there is a direct correlation between increases in homicide
rates in Central American countries and increases in apprehensions of migrant
children at the U.S. southern border.22
Methodology
Study sample and data set
The research team, comprised of faculty from the University of California, Los
Angeles (UCLA), graduate students from the UCLA Fielding School of Public
Health, medical students from the David Geffen School of Medicine at UCLA, and
Physicians for Human Rights (PHR) staff, analyzed 132 medical-legal affidavits
conducted by volunteer clinicians in the PHR Asylum Network for the purpose of
describing the lived experiences of people harmed by domestic and gang violence.
The study uses qualitative analysis to capture the dynamics and characteristics of
the harms the survivors experienced which are relevant for the criteria for
international protection. These include the severity of the harm; how their harm
was perceived by their families, communities, and governments; their visibility as
a group to perpetrators; their community and their government; and how their
own sense of self was impacted. The study also explored descriptive statistics that
could expose discriminatory patterns of harm that were not captured through the
qualitative analysis. Our hypothesis was that the physical and psychological
findings in medical-legal affidavits would map onto the legal criteria for asylum
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Domestic Violence and Gang Violence
Qualify for International Protectionand bring new insights for informing coalition efforts to improve asylum policies
for these individuals.
Among 1,944 cases placed with clinical experts for evaluation by PHR between
1996 and 2019, PHR was able to confirm that at least 1,017 received some form of
humanitarian immigration status and at least 812 received asylum. Of those cases
with positive outcomes, and for which a written evaluation was available, PHR
identified 149 that were based on the claim of domestic and/or gang violence
experienced in the person’s home country. Seventeen were subsequently
excluded, including 15 cases where the main trauma occurred in the United
States rather than in the country of origin, leaving 132 affidavits for analysis.23
The research team focused on successful cases in order to broadly capture the
characteristics of people qualifying for asylum on the basis of domestic and gang
violence over past decades.
Coding tool development and quality assurance
The research team developed a coding tool to extract quantitative and qualitative
data from affidavits, drawing on questions from validated questionnaires such as
the Harvard Trauma Questionnaire and diagnostic criteria from the Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Medical,
legal, and policy experts reviewed the coding tool, which was then formatted in
the online survey platform Qualtrics. UCLA faculty and PHR staff trained the
student coders on how to use the coding tool and provided on-going supervision
to ensure consistency in data abstraction.
Quantitative analysis of narrative data
Researchers coded trauma exposures into 26 distinct trauma types and five main
categories: physical violence; sexual violence, other abuse, including verbal and
emotional abuse; indirect trauma, including threats to or violence against loved
ones; and targeted economic marginalization, including extortion. Researchers
defined seven categories of perpetrators and assigned one or more to each act of
abuse. Mental health outcomes were defined for 101 affidavits that included a
mental health evaluation; researchers coded DSM-5 diagnoses when the clinician
author explicitly stated in the affidavit that the client met clinical criteria at the
time of the evaluation. Researchers also looked for five categories of resilience
factors based on the academic literature24: family and social support, religion and
collective identity, work and school, access to mental and other clinical health
services, and other factors internal to the individual such as optimism or courage.
Using these codes, researchers calculated proportions for key categories,
including trauma exposures, perpetrators, and mental health outcomes.
Researchers then developed multiple logistic regression models to quantify the
association between the trauma that the client was exposed to, their resilience
factors, and each of two primary mental health outcomes: any DSM-5 diagnosis
and improved mental health symptoms.
Qualitative analysis
Researchers performed qualitative analysis on 35 free-text response items,
including ones related to the trauma narrative, motivation of perpetrators,
reasons for not reporting abuse or seeking state protection, and changes in
mental health following migration. To ensure accuracy, items with more than 80
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Domestic Violence and Gang Violence
Qualify for International Protectionresponses were reviewed independently by a pair of study authors who then
discussed discrepancies until consensus was achieved.
Limitations
This sample of affidavits from PHR’s database was not designed to be
representative of all cases of people seeking asylum in the United States. In order
for a case to be included in the PHR database prior to 2020, the client must have
applied for asylum and had access to an attorney who requested an evaluation
from PHR. Access to legal representation among asylum seekers is inconsistent,
with Central American asylum seekers less likely than other nationalities to have
representation.25 We restricted the sample to cases where the applicant obtained
asylum, in order to broadly capture the characteristics of people qualifying for
asylum on the basis of domestic or gang violence over past decades. We cannot
extrapolate these findings to represent clients who were not successful in
obtaining asylum in the United States. Medical and mental health diagnoses were
determined by clinician report rather than uniform administration of validated
instruments. Clinicians often did not report the presence or absence of all DSM-5
diagnostic criteria in their affidavits, so diagnoses could not be independently
validated by the coders. This data therefore reflects the assessments of clinicians
with varying health backgrounds and levels of experience, although all clinicians
have completed PHR’s documentation training and application and vetting
process. These affidavits generally underreport violence and abuse, since
attorneys assisting these applicants may ask the clinician to focus on the first,
worst, or most recent traumatic incidents rather than documenting all incidents
over the person’s lifetime.
Findings
Demographics of asylum seekers
In this study, 81 percent (107 people) were seeking asylum due to domestic
violence26 and 29 percent (38 people) due to persecution by organized gangs; 10
percent (13 people) had experienced both domestic and gang violence. In their
asylum claim, nearly all (92 percent) relied exclusively on membership in a
particular social group as their basis for asylum related to either domestic or gang
violence; a minority of affidavits (11 people, 8 percent) specified other protected
grounds for the asylum claim (race, religion, nationality, or political opinion).
The majority of affidavits in this study addressed asylum seekers who identified
as female (101 people, or 77 percent). This sample included affidavits of five
people who identified as LGBTQIA+: 10 percent (3/31) of people identifying as
men in the analyzed affidavits and 2 percent (2/101) of people identifying as
female. The majority of affidavits described people between the ages of 18 and 44
years old (75 percent) at the time of evaluation; 13 percent were under 18 years
old. The majority were from Latin America (67 percent) and more than half (55
percent) were from El Salvador, Guatemala, or Honduras, specifically. Twenty-
five percent were from Sub-Saharan Africa. The PHR evaluations were conducted
from 1999 to 2019, with the percentage of affidavits for clients from Central
American countries increasing in recent years (64 percent from 2009 to 2019 vs.
23 percent from 1999 to 2008, ppolicy enacted under the Trump administration. Most of the evaluations included
a mental health evaluation (101 affidavits, or 77 percent); a fewer number
included a physical evaluation (50 affidavits, 38 percent), including 7 affidavits (5
percent) which included a gynecological evaluation. The affidavits of 19 people
(14 percent) featured both mental health and physical or gynecological
evaluations.
The characteristics of those applying for asylum on the basis of domestic and
gang violence claims were remarkably similar. The only statistically significant
difference between these two groups was that those applying on the basis of
domestic violence were more likely to be female. Though the sample size was
small, statistical analysis found that those applying on the basis of gang violence-
related claims were more likely to identify as LGBTQIA+ than those applying
based on domestic violence.
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Domestic Violence and Gang Violence
Qualify for International ProtectionAsylum seekers experience multiple and compounded forms of
trauma
We looked in detail at the trauma narratives of the 132 people as captured in
medical-legal affidavits selected for this sample. According to data from the
affidavits, the applicants reported a wide range of trauma exposures: Of 26 types
of trauma, almost two thirds (65 percent) of applicants had experienced six or
more types. These trauma exposures were further grouped into five categories:
physical violence;27 sexual violence;28 other abuse, including verbal and
emotional abuse;29 indirect trauma, including threats to or violence against loved
ones;30 and targeted economic marginalization, including extortion.31 Nearly all
(95 percent) of the applicants had experienced multiple trauma categories: 78
percent had experienced three or more categories of trauma, while 15 percent had
experienced all five trauma categories. Targeted economic marginalization was
the least common category of trauma and was reported by 41 percent of
applicants, often in combination with other forms of trauma, for example as a
component of domestic violence; this category of abuse receives less emphasis in
forensic training for clinicians and may be underrepresented in medical
affidavits.
The physical and psychological trauma experienced by the survivors in this study
was severe, for some involving years of significant abuse which was actively or
tacitly condoned by their community as the abuse was normalized or the person
being abused was regarded as deserving this treatment.
For example, a 31-year-old woman from El Salvador reported that she
experienced abduction, sexual violence, social isolation, gang violence, and forced
prostitution, as a result of domestic abuse which was also gang-related:
“Ms. X described how Mr. Y first abducted, raped, and held her captive
and took her as his “woman” for numerous years, treating her as his
possession, and how others in her family and community refused to help
her or protect her. Ms. X described how Mr. Y began to beat and
humiliate her after giving birth to their first child together. Ms. X also
described how the beatings intensified after she became aware that Mr.
Y had joined a gang. Mr. Y also forced Ms. X to have sexual relations
with other men in their neighborhood in exchange for money that Mr. Y
kept.”
Domestic and gang violence claims demonstrated a similar number and type of
traumatic exposures.32 Women were much more likely to experience sexual
violence than men (85 percent vs. 13 percent, pClaims on the basis of domestic violence
Domestic violence is a complex category of trauma that includes many types of
abuse. Many, but not all, of the subjects applying for asylum on the basis of
domestic violence-related claims identified as female and reported experiencing
abuse by a male intimate partner. Other clients applying for asylum on the basis
of domestic violence had experienced multiple types of trauma at the hands of
multiple perpetrators, including family members. Family members were
sometimes violent towards applicants who were perceived as bringing shame
upon the family, including instances in which the applicant was unwilling to
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Domestic Violence and Gang Violence
Qualify for International Protection[Some] clients applying for asylum on the basis of
domestic violence had experienced multiple types of
trauma at the hands of multiple perpetrators, including
family members.
comply with gender norms. For example, a 16-year-old girl fled Guinea after
being forced by her father to marry a much older man. She was his fourth wife
and was repeatedly raped by her husband. When she asked her family for help,
her father threatened to kill her if she did not adhere to her husband’s wishes.
She was deeply fearful of her father because he beat her and her mother often.
Eventually she saved enough money to flee to a neighboring country. She later
heard that her father was looking for her to kill her for dishonoring him after
leaving her husband. She fled to the United States.
We classified female genital mutilation/cutting (FGM/C) carried out or ordered
by family members as a type of domestic violence rather than gang violence, since
the practice was carried out at the request of family members in the cases we
studied. FGM/C was experienced by 12 of the subjects in this sample of affidavits;
an additional five affidavits recorded the experience of people who experienced
threats of FGM/C that contributed to their decision to flee their home countries.
Several of the people applying for asylum on the basis of domestic violence were
minors who were left in the care of family members and subsequently faced
abuse; this finding that family separation creates new vulnerabilities is
corroborated by PHR research into the trauma of child migrants.33
An 18-year-old boy from Mexico was sexually abused by his male cousin after
being left with extended family as a child. He was told that if he reported the
abuse, he would suffer physical harm. In another case, a 32-year-old woman from
El Salvador was repeatedly sexually abused by her father after her mother, who
had fled to the United States, left her in the care of another family member.
In many of these examples, the applicant identified an unwillingness of their
family, community members, or officials to protect them on the basis of their
gender or position as a wife/female partner, which will be described later in the
report in the section on perpetrators.
A teenager who fled
domestic violence and
gang-related death threats
in El Salvador.
Photo: PHR photo library
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Domestic Violence and Gang Violence
Qualify for International ProtectionProfiles in Resilience: Why Survivors of Physicians for Human Rights phr.org 17 Domestic Violence and Gang Violence Qualify for International Protection
Claims on the basis of gang violence
Pervasive rhetoric by the Trump administration suggested that those applying for
asylum on the basis of gang violence-related claims are predominantly men or
teenage boys who may have experienced some level of gang involvement.34 While
this is true of some applicants, those applying for asylum on the basis of gang
violence-related claims represent a wide variety of people who have experienced
different types of gang-related trauma. Examples of applicants in this category
include those threatened after refusing to join a gang, those who experienced
extortion by gangs, those coerced into intimate partnerships with gang members,
and survivors of physical and sexual violence perpetrated by gang members,
many of whom were not gang members themselves but lived in a community
where gang violence was prevalent.
Both female and male applicants were targets of gang violence. Female
applicants, who comprised 61 percent of all subjects seeking asylum on the basis
of gang violence in this sample, more often reported sexual assault or
intimidation (83 percent of women versus 13 percent of men with gang-related
claims), whereas male applicants were more likely to report experiencing
intimidation and/or violence after refusing to join a gang. Overall, sexual violence
was very common in gang violence-related claims, with one third of applicants in
this category reporting having been raped and five percent reporting a history of
“gang rape” or rape by two or more perpetrators. Gang violence claims also
overlapped with domestic violence claims in 10 percent of the cases in this study.
The following example highlights several types of gang violence experienced by
clients who were not members of a gang. A 15-year-old boy from Honduras
described surviving years of violence and intimidation by local gangs. When he
was 10 or 11 years old, he was shot on the way home from playing soccer. He
recalls walking home behind a friend when a gang suddenly opened fire on them.
His acquaintance was killed while he was shot multiple times in his legs. About
one year later, one of his uncles was shot and paralyzed after rejecting an offer by
the local drug cartel to sell drugs; a different uncle was killed. His family was told
that reporting the incident to the police would be futile because the cartel had
paid them off. Eventually, a known rapist from a local gang began threatening the
client’s sister. This same gang member had raped the client’s cousin. His mother
A teenager who fled El
Salvador after his brother
was murdered for refusing
to join a local gang.
Photo: PHR photo library
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Domestic Violence and Gang Violence
Qualify for International ProtectionGang violence-related claims … include those
threatened after refusing to join a gang, those who
experienced extortion by gangs, those coerced into
intimate partnerships with gang members, and
survivors of physical and sexual violence perpetrated
by gang members.
soon purchased tickets for the client and his sister to flee to the United States,
given the impending likelihood of them being targeted directly by the gang. Thus,
while former gang members (many of whom are coerced to join) certainly do
apply for asylum, the experiences of people applying for asylum based on gang
violence is diverse.
Discrimination on the basis of sexual orientation
Though a small subset of the total number of affidavits, five applicants indicated
that the violence and discrimination they experienced due to their sexual
orientation was completely or partly related to their reason for fleeing. Out of
these five affidavits, three applicants identified as male and two identified as
female. All five of the applicants experienced domestic violence. In four out of the
five affidavits, applicants mentioned their parents as the main perpetrators of
violence related to their sexual orientation. In one out of the five affidavits, the
applicant indicated their intimate partner as the main perpetrator of physical and
sexual violence. One of the applicants experienced gang violence in addition to
domestic violence but there was no indication that the gang violence was
associated with the applicant’s sexual orientation.
Applicants reported that their family members harmed them after learning about
their sexual orientation, violence often rooted in anger related to their non-
A transgender woman from El Salvador who was harassed and sexually assaulted by police
officers.
Photo: PHR photo library
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Domestic Violence and Gang Violence
Qualify for International Protectionconformity with familial, social, and religious norms. A 25-year-old man from
Senegal stated that his father believed his orientation was a “personal, family,
and social outrage,” and, further, that his family could punish him with impunity
since homosexuality is a sin according to his country’s interpretation of Islam and
they would be protected from legal consequences.
Family disapproval and lack of community support also made it difficult for
applicants to protect themselves or to escape abuse. In another affidavit, a 41-
year-old woman from El Salvador described experiencing physical and sexual
abuse from her male intimate partner, with whom her parents had forced her into
a relationship to hide her sexual orientation. When she told him she liked
women, he started to physically abuse and rape her, even during her pregnancies.
She finally left her partner, but he threatened to find and kill her.
Targeted as a family member
Many applicants whose narratives were recorded in the affidavits used in this
study reported being targeted both individually and as a part of a family unit, and
directly connected kinship ties with heightened risk of harm. Overall, 38 percent
of applicants in this sample reported having a family member who had
experienced violence or had been killed as a sign that they were likely to be
targeted next; nearly half (48 percent) reported threats to family members and
others close to them. Perpetrators commonly threatened family members as a
powerful means of coercing, threatening, or exploiting their specific targets,
showing that indeed kinship ties can be a particular or socially distinct
characteristic which directly increases risks of harm. The emotional pain that
people experienced when perpetrators threatened or harmed family members
was severe and long-lasting, making it an extremely effective tactic.
For example, a 19-year-old young woman from El Salvador was told by gang
members that if she did not join the gang, they would start killing members of her
family. Although the family members were not involved and did not even know
about these threats, they were at direct risk due to being related to someone who
resisted joining a gang. In other cases, family members were at risk if they in any
way sought to protect or help their threatened family members or went to the
police. A 19-year-old young man from Ecuador described how gang members
threatened both him and his family to deter them from contacting the police
38 percent of applicants in this sample
reported having a family member who had
experienced violence or had been killed as a
sign that they were likely to be targeted next;
nearly half (48 percent) reported threats to
family members and others close to them.
A young Honduran woman who
was raped by gang members
trying to pressure her husband into
joining the gang.
Photo: PHR photo library
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Domestic Violence and Gang Violence
Qualify for International Protectionabout the extortion and robbery they suffered. Domestic abusers also used this
tactic in order to coerce and silence their victims. A 38-year-old woman from
Côte d’Ivoire reported that she stayed in a highly abusive relationship for many
years because her partner threatened to kill their children if she left him. A 63-
year-old woman from Bolivia did not tell her family members about the abuse she
suffered because her abusive husband threatened to beat up or kill her father if he
were to come and try to protect her, stating “I will hurt the most sensitive things
you have.”
Cyclical and multi-generational nature of abuse
The trauma narratives highlight the cyclical nature of violence within many
communities, particularly in the case of domestic violence. In some cases, female
applicants who experienced domestic abuse at the hands of intimate partners had
also experienced or witnessed domestic violence as children. For example, a 45-
year-old woman from Honduras reported witnessing abuse of her mother by her
biological father until she was eight years old. Following her mother’s remarriage,
she was sexually abused by her stepfather. She attempted to report the abuse to
her mother, who did not believe her. Eventually, the client began a relationship
with a man who then physically abused her for many years. She later escaped this
relationship and then began dating another man who later physically abused her.
After multiple attempts to relocate to avoid him, she ultimately fled to the United
States.
Another case illustrated how parents, children, and other family members may
experience nearly identical forms of physical and sexual violence perpetrated by
the same abuser. An 11-year-old girl from El Salvador resided with her maternal
grandparents after her mother fled to the United States to avoid violence by MS-
13 gang members. Her maternal grandfather often verbally abused the client and
threatened to “cut off her head.” The client’s grandfather physically abused her,
including one instance in which he struck her back with a machete. The client
also witnessed her grandfather physically abusing others, including her cousin.
The client’s grandfather had a history of physically and sexually abusing his own
wife and children. Specifically, the client’s maternal grandfather had raped her
mother and physically abused the client’s mother and sisters by hitting them with
objects such as ropes, belts, tree branches, and machetes. The client was
eventually sent to the United States with a smuggler to be reunited with her
parents. She reported having suicidal thoughts because of the trauma she had
experienced. This example highlights the intergenerational impact of abuse,
particularly when families and communities are unable or unwilling to confront
or bring the perpetrator to justice.
This cyclical nature of abuse has been documented extensively in the literature on
domestic violence and is often linked to the pervasive devaluation of women’s
lives and normalization of violence against women by multiple perpetrators
across generations. The coping mechanisms that domestic violence survivors
develop to survive, such as self-blame, isolation, and walking on eggshells, often
put them at risk of re-victimization.35 Empirical research corroborates this
study’s findings on the cyclical nature of abuse, finding that male perpetrators of
intimate partner violence were more likely to have witnessed domestic violence
between their parents than non-perpetrators and that women who were exposed
to domestic violence as children were more likely to become victims of intimate
partner violence.36
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Domestic Violence and Gang Violence
Qualify for International ProtectionMotivations of perpetrators: animosity towards non-conformity
to community norms
Intimate partners were the most commonly identified perpetrators of both
physical violence (57 percent) and sexual violence (69 percent). Intimate partners
were significantly more likely to be perpetrators in domestic violence claims
compared to gang violence claims, though they still represented a key group of
perpetrators in gang violence claims. Amongst gang-related claims, gang
members themselves were rarely identified as perpetrators of sexual violence
(1/21=5 percent); extended family members (29 percent) and intimate partners
(48 percent) were more often perpetrators of sexual violence in this group.
Greater than one in five clients named multiple perpetrators, highlighting the
numerous, compounded traumas that contributed to their asylum claims.
Affidavits captured the complicated social and gender norms, sense of male
entitlement, and systemic disempowerment of women that motivated intimate
partners to inflict physical and sexual violence. One client, a 35-year-old woman
from Guatemala, described enduring 17 years of rape, economic abuse, emotional
abuse, and physical abuse at the hands of her intimate partner. Her abuser
claimed that she must obey him, that he could and would have sex with her
whenever he pleased because it was his right as a man, and that women should be
subservient to men. She fled after surviving several attempts on her life. These
pervasive beliefs about the obligations of women within intimate relationships
were prevalent amongst perpetrators of intimate partner violence; moreover,
they reflected broader perceptions among local community members that
condoned and legitimized abuse of individuals based on gender.
Parents, guardians, and extended family members also perpetrated physical
violence (41 percent) and sexual violence (19 percent). Many clients reported that
their family members were motivated by adherence to social, religious, and
community norms, such as the maintenance of male-dominant power structures
within the family or the avoidance of familial “shame” caused by non-conformity
to these customs.
Female clients were subjected to forced marriage, female genital
mutilation/cutting, and physical violence driven by well-established cultural
norms and harmful practices, such as the understanding that women are
property rather than autonomous agents. One 33-year-old woman from Mali was
beaten by her father and brothers several times when she refused to enter a
forced marriage. She was told by her family that who she married was not her
choice but that of the male family members. Another woman from Kenya
endured years of trauma, including rape by her maternal uncle, forced female
genital mutilation/cutting, and forced marriage to a much older man. She
eventually fled to the United States, but was told that should she return, she
would be forced to marry a member of her late husband’s family because she was
still the property of the family.
In some cases, the applicants also reported not realizing that the abuse they
endured was wrong because the subjugation of women is so normalized in their
community. A 42-year-old woman from Mexico stated that her husband would
force her to have sex when he was drunk, telling her that it was her duty as his
wife. At that time, she had internalized his view of her to such a degree that it did
not even occur to her to try to escape.
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Domestic Violence and Gang Violence
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